Mandates at Center of Democratic Civil War Over Health Care

The Senate health care compromise does not
include a public option or a Medicare buy-in. This has enraged liberal
Democrats like Howard Dean, who now say Democrats should kill the bill. Dean's theatrics inspired in turn a vicious backlash from moderate Democrats who insist the compromise is better than nothing.
At the center of the rapidly escalating dispute is the mandate, which
will require everyone to buy health insurance. Dean and others warn
that, without a cost-controlled public option, the mandate will be a
fiat for insurance companies and will bankrupt middle-class Americans.
Backers of the mandate counter that legislation includes enough
cost controls to mitigate the danger. Here are the battle lines in Democratic strife over the mandate.

Kill the Bill: Against the Mandate

Bailout For Insurance CompaniesHoward Dean said on Good Morning America that the mandate would be "a bigger bailout for the insurance industry
than AIG." He added, "This is an insurance company's dream, this bill
[...] This is essentially the collapse of health care reform in the United States Senate." Digby dismisses the mandate as "basically a deal with the insurance industry to accept 30 million
coerced customers in exchange for ending their practice of failing to
cover their customers when they get sick [...] If that's the best we can expect of progressivism
for the next generation then I'm afraid we are in deep trouble."

'Neo-Feudalism' By Insurance IndustryMarcy Wheeler is furious. "The bill, if it became law, would legally require a portion of Americans to
pay more than 20% of the fruits of their labor to a private corporation
in exchange for 70% of their health care costs," she writes. "Senate Democrats are requiring middle class families to give the
proceeds of over a month of their work to a private corporation-one
allowed to make 15% or maybe even 25% profit on the proceeds of their
labor. [...] It's the same kind of deal peasants made under feudalism: some
proportion of their labor in exchange for protection (in this case,
from bankruptcy from health problems, though the bill doesn't actually
require the private corporations to deliver that much protection). In
this case, the federal government becomes an appendage to do
collections for the corporations.

Why It Won't Work FireDogLake's Jon Walker fumes, "Private insurance companies do a terrible job of providing
cost-effective health insurance. The awful decision to give these
inefficient insurance companies massive subsidies to cover Americans,
who would be forced to buy their bad products, only results in a
relatively small increase in insurance coverage at a huge cost. The
idea that these companies, proven to be failures at controlling costs,
would be given huge amounts of money without any new public competition
to keep them honest is mind boggling."

Dems Must Dump Mandate Daily Kos chief Markos Moulitsas proposes how.
"The mandate puts the government in the untenable position of forcing
everyone to buy a shitty product from private companies enjoying
ant-monopoly protections," he writes. "[A] progressive should step up
with an amendment to strip out the mandate." Republicans, he says, will
surely join in removing the mandate for fear of enraging the
"teabaggers" who so oppose it.

Pass The Bill: For the Mandate

What's Right With Mandate White House Press Secretary Robert Gibbs hits back.
"[N]obody will be required to purchase something they can't
afford. There are hardship exemptions and subsidies based on income
levels that help people afford insurance," he said today. "So, you
know, I don't know what piece of legislation he's
reading. Let me tell you what is good in the bill, that is true, that
Dr. Dean forgot to tell people about this morning." Gibbs detailed
insurance industry reforms, cost-cutting measures, and the 30 million
he says will be provided insurance.

Moral Case For Mandate The New Republic's Jonathan Cohn makes it. "We want a system that
includes everybody, and that means everybody paying what they can for
coverage. There's also a more practical rationale. Without a mandate,
young and relatively healthy people might decide not to buy insurance,
because they figure they're unlikely to have high medical expenses.
(Insurance only works when there's a large number of people paying in,
so there are enough contributions from the majority who are healthy to
offset the costs of those who are sick.) Besides, even young and
healthy people can end up with high medical expenses, from an accident
or a serious disease. Forcing them to get insurance is actually in
their own interest."

'Importance Of The Individual Mandate' The Washington Post's Ezra Klein explains that under this plan, "An insurer will have to offer insurance at the same price to a diabetic and a triathlete.But if you remove the individual mandate, you're caught in the
reverse of our current problem: The triathlete doesn't buy insurance.
Fine, you might say. Let the insurer get gamed. They deserve it. The insurers, however, are not the ones who will be gamed. The sick
are." If only the sick buy insurance, costs sky-rocket, but if everyone
buys it, costs are spread across the board. Besides, "In a world with
an individual mandate, insurance has to be affordable. If it's not, there's a huge political backlash."

Let's Get Real HereMatthew Yglesias urges compromise. "Personally, I'd be happier with Swedish health care
or what have you. But politics is about real impacts on the lives of
real people, and measures that make things better are very good
measures," he writes. "[Y]ou can call the health care bill an 'insurance company bailout.' But
the mechanism by which insurers can get extra money under reform is
that . . . more people get health insurance at a price they can afford.
The bill will also expand Medicaid eligibility to include many
currently uncovered poor and near-poor people."